You have just received change-of-shift report about these patients on the coronary step down unit. Which one will you assess first?

Correct Answer: B

Rationale: In this scenario, the correct answer is option B, the 45-year-old with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before the shift change. This patient should be assessed first because acute dyspnea and agitation are signs of respiratory distress and potential cardiac decompensation, which require immediate attention to prevent further deterioration. Option A, the 26-year-old with heart failure caused by congenital mitral stenosis scheduled for balloon valvuloplasty later today, can be assessed after addressing the patient in distress due to the acuity of the situation. Option C, the 56-year-old who had a coronary angioplasty and stent placement yesterday and complains of occasional chest pain, is stable post-procedure and can be assessed after the patient in distress is attended to. Option D, the 77-year-old with a post-operative temperature elevation after coronary artery bypass grafting, requires assessment for potential infection or other post-operative complications but can wait until the patient in acute distress is evaluated and stabilized. In an educational context, this question emphasizes the prioritization of patient care based on the urgency of the situation. It highlights the importance of recognizing and responding promptly to signs of acute distress in patients with cardiovascular conditions to ensure optimal outcomes. Prioritization skills are crucial for healthcare professionals to provide safe and effective care in fast-paced clinical settings.

Correct Answer: D

Rationale: In the context of a client with mitral valve prolapse, it is essential for a nurse to discourage alcohol consumption due to its potential to cause cardiac stimulation. Mitral valve prolapse is a condition where the valve between the left atrium and left ventricle of the heart doesn't close properly, leading to backflow of blood. Alcohol consumption can exacerbate this by increasing heart rate and potentially causing arrhythmias, putting additional strain on the already compromised valve. Option A, tachycardia, is not the primary reason for discouraging alcohol consumption in mitral valve prolapse. While alcohol can indeed lead to tachycardia, the specific concern in this scenario is the direct cardiac stimulation that can worsen the condition. Option B, cinchonism, is unrelated to alcohol consumption and mitral valve prolapse. Cinchonism is a condition caused by excessive quinine consumption. Option C, hypertension, is not directly linked to alcohol consumption in the context of mitral valve prolapse. Alcohol can contribute to hypertension in general, but the focus here is on the cardiac effects specific to the valve condition. Educationally, understanding the impact of alcohol on cardiovascular conditions like mitral valve prolapse is crucial for nurses to provide holistic care. By grasping the physiological effects of alcohol on the heart, nurses can effectively educate patients on lifestyle modifications to manage their condition and prevent complications.

Correct Answer: D

Rationale: In the scenario presented, the correct nursing intervention to maintain adequate cardiac output in a client with dysrhythmia and decreased cardiac output is to provide supplemental oxygen (Option D). Supplemental oxygen helps to increase the oxygen supply to the heart muscle, which is crucial in enhancing cardiac output and improving tissue perfusion. Option A, encouraging mild exercises, would not be appropriate in this situation as it may further strain the heart and exacerbate the dysrhythmia, leading to a decrease in cardiac output. Placing the client in a supine position (Option B) may not necessarily address the underlying issue of decreased cardiac output and could even worsen certain dysrhythmias. Ensuring IV access (Option C) is important for administering medications or fluids, but it does not directly address the need to improve cardiac output in this case. Educationally, understanding the rationale behind providing supplemental oxygen in this context is crucial for nursing students and healthcare professionals. It reinforces the concept of oxygen therapy as a supportive measure in managing cardiac conditions to optimize cardiac function and tissue oxygenation. It also highlights the importance of critical thinking and prioritizing interventions based on the client's condition and needs.

Correct Answer: C

Rationale: The correct answer is A) Acute pulmonary edema occurs when there is a sudden increase in left ventricular end-diastolic pressure, leading to leakage of fluid into the alveoli and interstitial spaces in the lungs. This pathophysiology explanation is correct because acute pulmonary edema is primarily caused by an increase in hydrostatic pressure in the pulmonary capillaries, often due to left-sided heart failure. When the left ventricular end-diastolic pressure rises, it causes fluid to be pushed into the lung tissues, leading to symptoms such as dyspnea, orthopnea, and pink frothy sputum. Option B, C, and D are incorrect as they do not accurately describe the pathophysiology of acute pulmonary edema. It's important for students to understand the mechanism behind this condition to recognize the signs and symptoms, understand the treatment options, and grasp the importance of managing left-sided heart failure to prevent complications like acute pulmonary edema. Educational context: Understanding the pathophysiology of acute pulmonary edema is crucial for healthcare professionals, especially those working in cardiology, critical care, or emergency settings. By grasping the underlying mechanism of this condition, clinicians can provide timely and effective interventions to improve patient outcomes. This knowledge also underlines the importance of managing heart failure effectively to prevent complications like acute pulmonary edema.

Correct Answer: A

Rationale: In the context of a client who has undergone a prosthetic heart valve replacement, the short-term pharmacological approach used 1 to 2 months postoperatively is anticoagulant therapy. This is the correct answer for several reasons: 1. **Prevention of Thrombosis:** Anticoagulant therapy is crucial in preventing thrombosis around the prosthetic valve, which is a significant risk post-surgery due to the foreign material of the valve and changes in blood flow dynamics. 2. **Reduce Clot Formation:** Anticoagulants like warfarin or heparin help in reducing the formation of blood clots that can obstruct the prosthetic valve, leading to life-threatening complications like valve thrombosis. 3. **Duration of Therapy:** The initial 1 to 2 months post heart valve replacement are critical for preventing clot formation, and anticoagulant therapy is the standard of care during this period. Now, let's discuss why the other options are incorrect: - **B) Antibiotic therapy:** While infection prophylaxis is important in the postoperative period, it is not the primary pharmacological approach for the first 1-2 months after heart valve replacement unless there is a specific indication for antibiotic therapy. - **C) ACE Inhibitor therapy:** ACE inhibitors are not the first-line therapy in the immediate postoperative period after heart valve replacement. They are typically used for conditions like hypertension or heart failure. - **D) Beta Blocker therapy:** Beta blockers are important in managing certain cardiovascular conditions like hypertension or heart failure, but they are not the primary pharmacological approach immediately after a prosthetic heart valve replacement. In an educational context, understanding the rationale behind the choice of anticoagulant therapy post prosthetic heart valve replacement is crucial for healthcare professionals involved in the care of these patients. It highlights the importance of preventing thrombosis and ensuring the optimal functioning of the prosthetic valve to improve patient outcomes and reduce the risk of complications.